膀胱癌组织Ki-67、p53和CK-20的表达及与肿瘤病理特征和患者预后的关系

Expressions of Ki-67, p53, and cytokeratin 20 in bladder cancer tissues: Correlation with tumor pathological characteristics and patient prognosis

摘要:

目的 分析膀胱癌组织Ki-67、p53和细胞角蛋白20（CK-20）的表达及与肿瘤特征及患者预后的关系。方法 回顾性分析2018年1月—2021年2月无锡市中医医院接收的103例膀胱癌患者的临床资料。取患者肿瘤组织和癌旁组织，分别检测Ki-67、p53和CK-20的表达。比较肿瘤组织与癌旁组织Ki-67、p53、CK-20阳性表达情况，分析肿瘤组织Ki-67、p53、CK-20蛋白表达与临床病特征（病理类型、临床分期、肿瘤数目、肿瘤直径、淋巴结转移、浸润性）的关系。对所有患者进行为期3年的随访，根据患者是否肿瘤复发、转移、出现新病灶或死亡，将患者分为预后良好组（71例）和预后不良组（32例），比较两组患者肿瘤组织Ki-67、p53、CK-20表达情况，通过多因素一般Logistic回归模型分析蛋白表达与预后的关系。结果 肿瘤组织Ki-67、p53、CK-20阳性表达率均高于癌旁组织（P <0.05）。T_3、4分期、有淋巴结转移和浸润性患者肿瘤组织Ki-67、p53、CK-20阳性表达率更高（P <0.05）。预后不良组肿瘤组织Ki-67、p53、CK-20阳性表达率均高于预后良好组（P <0.05）。多因素一般Logistic回归分析结果显示：Ki-67高表达［O^R=8.699（95% CI：2.253，33.591）］、p53高表达［O^R=10.582（95% CI：2.175，51.492）］、CK-20高表达［O^R=5.486（95% CI：1.375，21.885）］均是膀胱癌患者预后不良的危险因素（P <0.05）。受试者工作特征曲线结果显示，Ki-67、p53、CK-20联合预测膀胱癌患者预后不良的敏感性为75.0%（95% CI：0.566，0.885），特异性为77.5%（95% CI：0.660，0.865），曲线下面积为0.805（95% CI：0.720，0.890）。结论 膀胱癌组织Ki-67、p53和CK-20的表达均会升高，且与患者预后密切相关。

Abstract:

Objective To analyze the relationship between the expressions of Ki-67, p53, and cytokeratin 20 (CK-20) in bladder cancer tissues and tumor characteristics as well as patient prognosis.Methods A retrospective analysis of clinical data from 103 bladder cancer patients admitted to our hospital from January 2018 to February 2021 was performed. The expressions of Ki-67, p53, and CK-20 were examined in tumor tissues and adjacent non-tumor tissues. The positive expression rates of Ki-67, p53, and CK-20 in tumor tissues versus adjacent tissues were compared, and the correlations between protein expressions in tumor tissues and clinicopathological features (pathological pattern, clinical stage, number of tumors, tumor diameter, lymph node metastasis, invasiveness) were analyzed. A three-year postoperative follow-up was conducted for all patients, who were classified into the good prognosis (n = 71) and poor prognosis (n = 32) groups based on whether they experienced tumor recurrence, metastasis, new lesions, or death. The expressions of Ki-67, p53, and CK-20 in these groups were compared, and multivariable Logistic regression analysis was used to determine the association between protein expressions and prognosis.Results The positive expression rates of Ki-67, p53, and CK-20 in tumor tissues were significantly higher than those in adjacent tissues (P < 0.05). In patients with T3 and T4 stage tumors, lymph node metastasis, and invasive tumors, the positive expression rates of Ki-67, p53, and CK-20 in tumor tissues were even higher (P < 0.05). In the poor prognosis group, the positive expression rates of Ki-67, p53, and CK-20 in tumor tissues were also higher than those in the good prognosis group (P < 0.05). Multivariable Logistic regression analysis showed that high expressions of Ki-67 [O^R = 8.699 (95% CI: 2.253, 33.591) ], p53 [O^R = 10.582 (95% CI: 2.175, 51.492) ], and CK-20 [O^R = 5.486 (95% CI: 1.375, 21.885) ] were independent risk factors for poor prognosis in bladder cancer patients (P < 0.05). ROC curve analysis indicated that the sensitivity of combined detection of Ki-67, p53, and CK-20 was 75.0% (95% CI: 0.566, 0.885), with a specificity of 77.5% (95% CI: 0.660, 0.865), and an area under the curve of 0.805 (95% CI: 0.720, 0.890).Conclusions The expressions of Ki-67, p53, and CK-20 in bladder cancer tissues are increased and closely related to the postoperative prognosis of the patients.